This
emergency administrative regulation is being promulgated to establish a new
reimbursement methodology for community mental health center services. This
action must be taken on an emergency basis to comply with a federal mandate (Centers
for Medicare and Medicaid Services) and to prevent the loss of federal funds. This
emergency administrative regulation differs from the emergency administrative
regulation that was filed with the Legislative Research Commission on December 30,
2013 in that it establishes: a new reimbursement methodology for community
mental health center services; and reimbursement for primary care services
provided in community mental health centers. This emergency administrative regulation
shall be replaced by an ordinary administrative regulation filed with the
Regulations Compiler. The ordinary administrative regulation differs from this
emergency administrative regulation in that it: establishes interim
reimbursement for injectable drugs, defines "injectable drug", and
defines "rebatable drug"; establishes interim reimbursement for
primary care services and establishes unit durations for primary care services;
does not establish an interim reimbursement for the period beginning January 1,
2015 and ending June 30, 2015 as the ordinary administrative regulation is not
anticipated to be in effect during that period; does not contain the
requirement that a cost report be submitted by each CMHC to the Department for
Medicaid Services by April 1, 2015 as the ordinary administrative regulation
will not be in effect on April 1, 2015; and addresses interim reimbursement
beginning July 1, 2016.

NECESSITY,
FUNCTION, AND CONFORMITY: The Cabinet for Health and Family Services,
Department for Medicaid Services has responsibility to administer the Medicaid
Program. KRS 205.520(3) authorizes the cabinet, by administrative regulation,
to comply with any requirement that may be imposed or opportunity presented by
federal law to qualify for federal Medicaid funds. This administrative
regulation establishes the reimbursement provisions and requirements regarding
community mental health center services provided to Medicaid recipients who are
not enrolled with a managed care organization.

Section
1. Definitions. (1) "Community board for mental health or individuals
with an intellectual disability" means a board established pursuant to KRS
210.380.

(2)
"Community mental health center" or "CMHC" means a facility
which meets the community mental health center requirements established in 902 KAR
20:091.

(3)
"CPT code" means a code used for reporting procedures and services
performed by medical practitioners and published annually by the American
Medical Association in Current Procedural Terminology.

(4)[(2)]
"Department" means the Department for Medicaid Services or its
designee.

(5)[(3)]
"Enrollee" means a recipient who is enrolled with a managed care
organization.

2.
Not provided by the CMHC acting as a 1915(c) home and community based waiver
services provider;

3.
Provided to recipients who are not enrolled with a managed care organization;
and

4.
Medically necessary; and

(b)
Based on the community mental health center’s Medicaid allowable costs.

(2)
The department’s reimbursement shall include reimbursing:

(a)
On an interim basis during the course of a state fiscal year; and

(b)
A final reimbursement for the state fiscal year that results from a
reconciliation of the interim reimbursement amount paid to the CMHC by the
department compared to the CMHC’s Medicaid allowable costs for the state fiscal
year.

Section
3. Interim Reimbursement for Behavioral Services Spanning January 1, 2015
through June 30, 2015. The department shall reimburse a CMHC on an interim
basis for a Medicaid-covered behavioral health service:

(1)
Rendered:

(a)
To a recipient who is not enrolled with a managed care organization; and

(b)
Anytime from January 1, 2015, through June 30, 2015; and

(2)
At the rate in effect for the service on December 31, 2014.

Section
4. Interim Reimbursement for Behavioral Health Services Spanning July 1, 2015
through June 30, 2016. (1) By April 1, 2015, a CMHC shall submit a cost report
to the department:

(a)
In a format that has been approved by the Centers for Medicare and Medicaid Services;
and

(b)
That states all of the:

1.
CMHC’s Medicaid allowable costs for Medicaid-covered services rendered to recipients
during the period beginning July 1, 2013, and ending June 30, 2014;

2.
CMHC’s costs associated with Medicaid-covered services rendered to enrollees
during the period beginning July 1, 2013, and ending June 30, 2014;

3.
Costs of the community board for mental health or individuals with an
intellectual disability under which the CMHC operates for the period beginning July
1, 2013, and ending June 30, 2014; and

4.
CMHC’s costs associated with services rendered to individuals:

a.
That were reimbursed by an insurer or party other than the department or a
managed care organization; and

b.
During the period beginning July 1, 2013, and ending June 30, 2014.

(2)
The department shall:

(a)
Review the cost report referenced in subsection (1) of this section; and

2.
Based on Medicaid allowable costs as determined by the department through its review;
and

3.
Intended to result in a reimbursement for Medicaid-covered behavioral health services:

a.
Provided to recipients who are not enrollees;

b.
For the period July 1, 2015, through June 30, 2016; and

c.
That equals the department’s estimate of behavioral health services’ costs for
the CMHC for the period.

Section
5. Final Reimbursement for Services Provided from January 1, 2015 through June
30, 2015. (1) By December 31, 2015, a CMHC shall submit a cost report to the department:

(a)
In a format that has been approved by the Centers for Medicare and Medicaid Services;

(b)
That has been audited by an independent auditing entity; and

(c)
That states all of the:

1.
CMHC’s Medicaid allowable costs for Medicaid-covered services rendered to recipients
during the period beginning July 1, 2014, and ending June 30, 2015;

2.
CMHC’s costs associated with Medicaid-covered services rendered to enrollees
during the period beginning July 1, 2014, and ending June 30, 2015;

3.
Costs of the community board for mental health or individuals with an
intellectual disability under which the CMHC operates for the period beginning July
1, 2014, and ending June 30, 2015; and

4.
CMHC’s costs associated with services rendered to individuals:

a.
That were reimbursed by an insurer or party other than the department or a
managed care organization; and

b.
During the period beginning July 1, 2014, and ending June 30, 2015.

(2)
The department shall:

(a)
Review the cost report referenced in subsection (1) of this section;

(b)
Determine the amount of Medicaid allowable costs for the dates of service
beginning January 1, 2015, through June 30, 2015; and

(c)
Compare the amount of Medicaid allowable costs referenced in paragraph (b) of
this subsection to the department’s interim reimbursement for Medicaid-covered services
provided during the dates of service beginning January 1, 2015, through June
30, 2015.

(3)(a)
After the department compares a CMHC’s interim reimbursement with the CMHC’s
Medicaid allowable costs for the period referenced in subsection (2) of this
section, if the department determines that the interim reimbursement:

1.
Was less than the CMHC’s Medicaid allowable costs for the period, the department
shall send a payment to the CMHC equal to the difference between the CMHC’s
total interim reimbursement and the CMHC’s Medicaid allowable costs; or

2.
Exceeded the CMHC’s Medicaid allowable costs for the period, the:

a.
Department shall send written notification to the CMHC requesting the totalamount of the overpayment; and

b.
CMHC shall, within thirty (30) days of receiving the department’s written
notice, send a:

(i)
Payment to the department equal to the excessive amount; or

(ii)
Payment plan request to the department.

(b)
A CMHC shall not implement a payment plan unless the department has approved
the payment plan in writing.

(c)
If a CMHC fails to comply with the requirements established in paragraph (a)2
of this subsection, the department shall:

1.
Suspend payment to the CMHC; and

2.
Recoup the amount owed by the CMHC to the department.

Section
6. Final Reimbursement for a State Fiscal Year Beginning with State Fiscal Year
2016. (1)(a) Beginning with the state fiscal year that begins July 1, 2015, and
ends June 30, 2016, by December 31 following the end of the state fiscal year,
a CMHC shall submit a cost report to the department:

1.
In a format that has been approved by the Centers for Medicare and Medicaid Services;

2.
That has been audited by an independent auditing entity; and

3.
That states all of the:

a.
CMHC’s Medicaid allowable costs:

(i)
For Medicaid-covered services rendered to recipients during the prior state fiscal
year; and

(ii)
For Medicaid-covered injectable drugs rendered to recipients during the prior
state fiscal year if the CMHC administered injectable drugs to recipients
during the time period;

b.
CMHC’s costs associated with:

(i)
Medicaid-covered services rendered to enrollees during the prior state fiscal
year; and

(ii)
Medicaid-covered injectable drugs rendered to enrollees during the prior state
fiscal year if the CMHC administered injectable drugs to enrollees during the
time period;

c.
Costs of the community board for mental health or individuals with an
intellectual disability under which the CMHC operates for the prior state fiscal
year; and

d.
CMHC’s costs associated with services rendered to individuals:

(i)
That were reimbursed by an insurer or party other than the department or a
managed care organization; and

(ii)
During the prior state fiscal year.

(b)
To illustrate the timeline referenced in paragraph (a) of this subsection, an
independently audited cost report stating costs associated with services and
injectable drugs provided during the state fiscal year spanning July 1, 2015,
through June 30, 2016, shall be submitted to the department by December 31,
2016.

(2)
By April 1 following the department’s receipt of a CMHC’s completed cost report
submitted to the department by the prior December 31, the department shall:

(a)
Review the cost report referenced in subsection (1) of this section;

(b)
Determine the amount of Medicaid allowable costs on the cost report; and

(c)
Compare the amount of Medicaid allowable costs referenced in paragraph (b) of
this subsection to the department’s interim reimbursement for Medicaid-covered
services and injectable drugs rendered during the same state fiscal year.

(3)(a)
After the department compares a CMHC’s interim reimbursement with the CMHC’s
Medicaid allowable costs for the period, if the department determines that the
interim reimbursement:

1.
Was less than the CMHC’s Medicaid allowable costs for the period, the department
shall send a payment to the CMHC equal to the difference between the CMHC’s
total interim reimbursement and the CMHC’s Medicaid allowable costs; or

2.
Exceeded the CMHC’s Medicaid allowable costs for the period, the:

a.
Department shall send written notification to the CMHC requesting the amount of
the overpayment; and

b.
CMHC shall, within thirty (30) days of receiving the department’s written
notice, send a:

(i)
Payment to the department equal to the excessive amount; or

(ii)
Payment plan request to the department.

(b)
A CMHC shall not implement a payment plan unless the department has approved
the payment plan in writing.

(c)
If a CMHC fails to comply with the requirements established in paragraph (a)2
of this subsection, the department shall:

1.
Suspend payment to the CMHC; and

2.
Recoup the amount owed by the CMHC to the department.

Section 7. New
Services. (1) Reimbursement regarding a projection of the cost of a new Medicaid-covered
service or expansion shall be made on a prospective basis in that the costs of
the new service or expansion shall be considered when actually incurred as an allowable
cost.

(2)(a) A CMHC may request an adjustment to an
interim rate after reaching the mid-year point of the new service or expansion.

desk review of each cost report to determine whether an
audit is necessary and, if so,

the scope of the audit.

(b) If the department determines that an audit
is not necessary, the cost report shall be settled without an audit.

(c) A desk review or audit shall be used for
purposes of verifying costs to be used in setting the interim behavioral health
services rate or for purposes of adjusting interim behavioral health services
rates which have been set based on unaudited data.

(2)(a) A CMHC shall maintain and make available
any records and data necessary to justify and document:

(b) The department shall have unlimited on-site
access to all of a CMHC’s fiscal and service records for the purpose of:

1. Accounting;

2. Auditing;

3. Medical review;

4. Utilization control; or

5. Program planning.

(3)
A CMHC shall maintain an acceptable accounting system to account for the:

(a)
Cost of total services provided;

(b)
Charges for total services rendered; and

(c)
Charges for covered services rendered to eligible recipients.

(4)
An overpayment discovered as a result of an audit or desk review shall be
settled through recoupment or withholding.

Section 9. Allowable and Non-allowable Costs.
(1) The following shall be allowable costs:

(a) Services' or drugs' costs associated with the
services or drugs;

(b) Depreciation as follows:

1. A straight line method shall be used;

2. The edition of the American Hospital
Association’s useful life guidelines currently used by the Centers for Medicare
and Medicaid Services’ Medicare program shall be used;

3. The maximum amount for expensing an item in
a single cost report shall be $500; and

4. Only the depreciation of assets actually
being used to provide services shall be recognized;

(c) Interest costs;

(d) Costs incurred for research purposes;

(e) Costs incurred for transporting recipients
to services;

(f) Costs of motor vehicles used by management
personnel up to $25,000;

(g) Costs for training or educational purposes
outside of Kentucky including transportation costs to travel to the training or
education;

(h) Costs associated with any necessary legal
expense incurred in the normal administration of the CMHC;

(i) The cost of administrative staff salaries,
which shall be limited to the average salary for the given position as
established for the geographic area onwww.salary.com; and

(j)1. The cost of practitioner salaries shall be limited to the
median salary for the southern region as reported in the Medical Group Management
Association (MGMA) Physician Compensation and Production Survey Report, if
available.

2.
A per visit amount using MGMA median visits shall be utilized.

3.
The most recently available MGMA publication that relates to the cost report
period shall be used.

(2)(a) The allowable cost for a service or good
purchased by a facility from a related organization shall be in accordance with
42 C.F.R. 413.17.

(3) The following shall not be allowable costs:

(a) Bad debt;

(b) Charity;

(c) Courtesy allowances;

(d) Political contributions;

(e) Costs associated with an unsuccessful
lawsuit against the department or the Cabinet for Health and Family Services;

(f) Costs associated with any legal expense
incurred related to a judgment granted as a result of an unlawful activity or
pursuit;

(g) The value of services provided by non-paid
workers;

(h) Travel or related costs or expenses
associated with attending:

1. A convention;

2. A meeting;

3. An assembly; or

4. A conference; or

(i) Costs related to lobbying.

(4) A discount or other allowance received regarding
the purchase of a good or service shall be deducted from the costs of the good
or service for cost reporting purposes.

(5)(a) Maximum allowable costs shall be the
maximum amount which may be allowed as reasonable cost for the provision of a
service or drug.

(b) To be considered allowable, any cost shall:

1. Be necessary and appropriate for providing
services; and

2. Not exceed usual and customary charges[as established in this subsection.

(a)
The payment rate that was in effect on June 30, 2002, for the community mental
health center for community mental health center services shall remain in
effect and there shall be no cost settling.

(b)
Allowable costs shall not:

1.
Exceed customary charges which are reasonable; or

2.
Include:

a.
The costs associated with political contributions;

b.
Travel or related costs for trips outside the state (for purposes of
conventions, meetings, assemblies, conferences, or any related activities);

c.
The costs of motor vehicles used by management personnel which exceed $20,000
total valuation annually (unless the excess cost is considered as compensation
to the management personnel); or

Section
10. Units of Service[3. Implementation of Payment System]. (1)(a)
Interim payments shall be based on units of service.

(b)
One (1) unit for each behavioral health service shall be defined as follows:

Service

Unit
of Service

Individual
Outpatient Therapy

15
minutes

Group
Outpatient Therapy

15
minutes

Family
Outpatient Therapy

15
minutes

Collateral
Outpatient Therapy

15
minutes

Psychological
Testing

15
minutes

Therapeutic
Rehabilitation

15
minutes

Medication
Prescribing and Monitoring

15
minutes

Physical
Examinations

15
minutes

Screening

15
minutes

Assessment

15
minutes

Crisis
Intervention

15
minutes

Service
Planning

15
minutes

Screening,
Brief Intervention, and Referral to Treatment

15
minutes

Mobile
Crisis Services

1
hour

Assertive
Community Treatment

Per
Diem

Intensive
Outpatient Program Services

Per
Diem

Residential
Crisis Stabilization Services

Per
Diem

Residential
Services for Substance Use Disorders

Per
Diem

Partial
Hospitalization

Per
Diem

Day
Treatment

1
hour

Comprehensive
Community Support Services

15
minutes

Peer
Support Services

15
minutes

(2)
An initial unit of service which lasts less than:

(a)
Fifteen (15) minutes for a service in which fifteen (15) minutes is the unit
amount may be billed as one (1) unit; or

(b)
The minimum amount for the service if the minimum amount is more than fifteen
(15) minutes may be billed as one (1) unit.

(3)
Except for an initial unit of a service, a service that is:

(a)
Less than one-half (1/2) of one (1) unit shall be rounded down; or

(b)
Equal to or greater than one-half (1/2) of one (1) unit shall be rounded up.

(4)
An individual provider shall not exceed four (4) units of service in one (1)
hour.

(5)
An overpayment discovered as a result of an audit shall be settled through
recoupment or withholding.

[(6)
A community mental health center shall maintain an acceptable accounting system
to account for the:

(a)
Cost of total services provided;

(b)
Charges for total services rendered; and

(c)
Charges for covered services rendered eligible recipients.

(7)
A community mental health center shall make available to the department all
recipient records and fiscal records:

(a)
At the end of each fiscal reporting period;

(b)
Upon request by the department; and

(c)
Subject to reasonable prior notice by the department.

(8)
Payments due a community mental health center shall be made at least once a
month.

Section
4. Nonallowable Costs. The department shall not reimburse:

(1)
Under the provisions of this administrative regulation for a service that is
not covered by 907 KAR 1:044; or

(2)
For a community mental health center's costs found unreasonable or nonallowable
in accordance with the Community Mental Health Center Reimbursement Manual.]

Section
11.[5.] Reimbursement of Out-of-state Providers. Reimbursement to
a participating out-of-state community mental health center shall be the lesser
of the:

(1)
Charges for the service;

(2)
Facility's rate as set by the state Medicaid Program in the other state; or

(3)
Upper limit for that type of service in effect for Kentucky providers.

Section
12.[6.] Appeal Rights. A community mental health center may
appeal a Department for Medicaid Services decision as to the application of
this administrative regulation in accordance with 907 KAR 1:671.

Section
13.[7.] Not Applicable to Managed Care Organization. A managed
care organization shall not be required to reimburse for community mental
health center services in accordance with this administrative regulation.

(b) The necessity of this administrative
regulation: This administrative regulation is necessary to establish DMS’s
reimbursement provisions and requirements regarding community mental health
center services.

(c) How this administrative regulation conforms to
the content of the authorizing statutes: This administrative regulation
conforms to the content of the authorizing statutes by establishing DMS’s
reimbursement provisions and requirements regarding community mental health
center services.

(d) How this administrative regulation currently
assists or will assist in the effective administration of the statutes: This
administrative regulation assist in the effective administration of the
authorizing statutes by establishing DMS’s reimbursement provisions and requirements
regarding community mental health center services.

(2) If this is an amendment to an existing
administrative regulation, provide a brief summary of:

(a) How the amendment will change this existing
administrative regulation: The amendment introduces a new cost-based reimbursement
methodology. Via the cost-based model the Department for Medicaid Services
(DMS) will ultimately reimburse for services rendered during a given year based
on Medicaid allowable costs after a thorough review of cost data reported by
each CMHC to determine such costs for each CMHC. As a given CMHC’s costs for a
year is reported after the year concludes and DMS must review the cost data
before determining the CMHC’s total Medicaid allowable costs for the year, DMS
reimburses each CMHC on an interim basis during the course of the year. After
completing the review and determination of a CMHC’s Medicaid allowable costs
for a year, DMS will compare its interim reimbursement paid to the CMHC during
the course of the year to the CMHC’s actual Medicaid allowable costs for the
year. If DMS’s interim reimbursement to the CMHC exceeded the CMHC’s Medicaid
allowable costs, the CMHC will send the overpayment amount to DMS. If DMS’s
interim reimbursement was less than the CMHC’s Medicaid allowable costs for the
year, DMS will issue a lump sum payment to the CMHC equaling the amount owed. The
reimbursement established in this administrative regulation only applies to
services rendered to Medicaid "fee-for-service" recipients. These are
Medicaid recipients who are not enrolled with a managed care organization.
Managed care organizations are not required to reimburse for CMHC services in accordance
with this administrative regulation.

(b) The necessity of the amendment to this
administrative regulation: The amendment establishing a new cost-based
reimbursement methodology is necessary as the Centers for Medicare and Medicaid
Services (CMS) mandated that the Department for Medicaid Services (DMS)
terminate its current CMHC services’ reimbursement (effective January 1, 2015)
and replace it with either a cost-based model or reimburse as Medicare does for
the services. The mandate results in part from an audit of a CMHC by the
Kentucky Auditor of Public Accounts. DMS shared the two (2) options with the
chief executive officers (CEOs) of the CMHCs and the CEOs elected the
cost-based reimbursement model.

(c) How the amendment conforms to the content of
the authorizing statutes: The amendments conform to the content of the
authorizing statutes by revising Medicaid reimbursement for community mental
health centers in a manner that complies with a federal mandate.

(d) How the amendment will assist in the effective
administration of the statutes: The amendments will assist in the effective
administration of the authorizing statutes by revising Medicaid reimbursement
for community mental health centers in a manner that complies with a federal
mandate.

(3) List the type and number of individuals,
businesses, organizations, or state and local government affected by this
administrative regulation: Community mental health centers - there are fourteen
(14) – will be affected by the amendment as will physicians, physician assistants,
and advanced practice registered nurses who wish to provide primary care services
in a CMHC.

(4) Provide an analysis of how the entities
identified in question (3) will be impacted by either the implementation of
this administrative regulation, if new, or by the change, if it is an
amendment, including:

(a) List the actions that each of the regulated
entities identified in question (3) will have to take to comply with this
administrative regulation or amendment. CMHCs will have to submit to DMS a cost
report in a format approved by the Centers for Medicare and Medicaid Services
(CMS) stating all of the CMHCs Medicaid allowable costs, costs associated with
care provided to recipients who are enrolled with a managed care organization, costs
experienced by the Community Board
for Mental Health or Individuals with an Intellectual Disability which oversees
the CMHC; and costs associated with services covered by another payor/party.

(b) In complying with this administrative
regulation or amendment, how much will it cost each of the entities identified
in question (3). CMHCs will experience administrative costs associated with tracking
and reporting costs data (including employing or contracting with personnel
capable of accurately tracking and reporting the data).

(c) As a result of compliance, what benefits will
accrue to the entities identified in question (3). CMHCs will benefit by receiving
reimbursement from DMS for services to Medicaid recipient who are not enrolled
with a managed care organization.

(5) Provide an estimate of how much it will cost
to implement this administrative regulation:

(a) Initially: DMS does not anticipate a substantial change in costs
associated with implementing the new cost-based reimbursement methodology
mandated by CMS but won’t know the full impact until after receiving cost
reports from CMHCs in the future.

(b) On a continuing basis: The response in paragraph
(a) also applies here.

(6) What is the source of the funding to be used
for the implementation and enforcement of this administrative regulation: The
sources of revenue to be used for implementation and enforcement of this administrative
regulation are federal funds authorized under the Social Security Act, Title
XIX and matching funds of general fund appropriations.

(7) Provide an assessment of whether an increase
in fees or funding will be necessary to implement this administrative
regulation, if new, or by the change if it is an amendment. Neither an increase
in fees nor funding is necessary to implement this administrative regulation.

(8) State whether or not this administrative
regulation establishes any fees or directly or indirectly increases any fees:
This administrative regulation neither establishes nor increases any fees.

(9) Tiering: Is tiering applied? Tiering is not
applied as the policies apply equally to the regulated entities.

2. State compliance standards. KRS 205.520(3)
states: "Further, it is the policy of the Commonwealth to take advantage
of all federal funds that may be available for medical assistance. To qualify
for federal funds the secretary for health and family services may by regulation
comply with any requirement that may be imposed or opportunity that may be
presented by federal law. Nothing in KRS 205.510 to 205.630 is intended to
limit the secretary's power in this respect."

3. Minimum or uniform standards contained in the
federal mandate. 42 U.S.C. 1396a(a)(10)(B) requires the Medicaid Program to ensure
that services are available to Medicaid recipients in the same amount,
duration, and scope as available to other individuals (non-Medicaid.) Expanding
the primary care provider base will help ensure Medicaid recipient access to
services statewide and reduce or prevent the lack of availability of services
due to demand exceeding supply in any given area.

4. Will this administrative regulation impose
stricter requirements, or additional or different responsibilities or
requirements, than those required by the federal mandate? The administrative
regulation does not impose stricter than federal requirements.

5. Justification for the imposition of the
stricter standard, or additional or different responsibilities or requirements.
The administrative regulation does not impose stricter than federal
requirements.

FISCAL NOTE ON
STATE OR LOCAL GOVERNMENT

1. What units, parts or divisions of state or
local government (including cities, counties, fire departments, or school
districts) will be impacted by this administrative regulation? The Department
for Medicaid Services will be affected by the amendment to this administrative
regulation.

2. Identify each state or federal statute or
federal regulation that requires or authorizes the action taken by the
administrative regulation. KRS 194A.030(2), 194A.050(1), 205.520(3).

3. Estimate the effect of this administrative
regulation on the expenditures and revenues of a state or local government
agency (including cities, counties, fire departments, or school districts) for
the first full year the administrative regulation is to be in effect.

(a) How much revenue will this administrative
regulation generate for the state or local government (including cities,
counties, fire departments, or school districts) for the first year? The
amendment is not expected to generate revenue for state or local government.

(b) How much revenue will this administrative
regulation generate for the state or local government (including cities,
counties, fire departments, or school districts) for subsequent years? The
amendment is not expected to generate revenue for state or local government.

(c)
How much will it cost to administer this program for the first year? DMS does
not anticipate a substantial change in costs associated with implementing the
new cost-based reimbursement methodology mandated by CMS but won’t know the
full impact until after receiving cost reports from CMHCs in the future.

(d)
How much will it cost to administer this program for subsequent years? The response
in (c) above also applies here.

Note:
If specific dollar estimates cannot be determined, provide a brief narrative to
explain the fiscal impact of the administrative regulation.